The present invention relates to a device for holding a surgical suture. More particularly, it relates to a device for selectively retaining one or more surgical sutures useful in a variety of surgical applications, such as those requiring a surgical retractor.
A number of surgical procedures require the use of sutures. Beyond closing an incision or other tissue opening, sutures are commonly employed to assist in the delivery and/or securement of prosthetics, retaining tissue and/or moving tissue to a desired location, etc. With these and similar procedures, a relatively large number of sutures are required, each of which must be securely held at a desired position for select periods of time during the procedure.
One exemplary surgical procedure requiring use of multiple sutures is open-heart surgery. For example, a coronary artery bypass (CAB) procedure, such as a beating heart CAB procedure, entails the surgeon performing a sternotomy or a thoracotomy in order to gain access to the chest cavity. A retractor system is then employed to spread apart bones and other tissue, defining an opening for performing the surgical procedure. In this regard, a series of sutures are placed through relevant tissue, such as vessels on the surface of the heart. Other sutures are employed to pull back and retain sections of tissue so as to ensure complete access to the surgical site. These and other sutures must be securely and firmly held throughout the surgical procedure.
The sutures utilized with open chest surgeries, as well as numerous other surgical applications, can be retained in a variety of fashions. For example, the suture ends can be clamped to a surgical drape otherwise covering the patient. Alternatively, a number of suture holders/organizers have long been available for securing a series of sutures in an organized fashion. Exemplary surgical suture organizer/holders are described, for example, in U.S. Pat. No. 4,185,636 to Gabbay et al.; U.S. Pat. No. 4,492,229 to Grunwald; and U.S. Pat. No. 5,207,703 to Jain.
For most applications, the suture retaining structure must be configured to provide releasable attachment of the suture in a manner that readily permits re-positioning and re-locking of the suture relative to the holder device. That is to say, the surgeon will typically desire to pull (or further retract) the suture following engagement with the holder device. As such, a potentially viable suture holding design may incorporate a rope cleat-like device in which a rotatable cam, otherwise providing a toothed surface, is rotated into and out of engagement with a rope abutment structure, thereby gripping a rope therebetween. Exemplary cam-type rope cleats are described, for example, in U.S. Pat. No. 4,766,835 to Randall et al. and U.S. Pat. No. 4,899,423 to Randall. While useful for gripping a relatively thick rope, existing cam-type rope cleats are ill-suited for surgical applications. For example, the handling concerns associated with relatively delicate suture material is not present, and thus not addressed, by a rope cleat. Further, most surgical applications require that any tool or device employed therewith be highly compact; this requirement is not addressed by rope cleats. Instead, because space is not an issue, rope cleats are typically quite large.
U.S. Pat. No. 6,290,644 to Green, II et al. (“Green, II”) represents one attempt at incorporating a cleat-like device into a surgical retractor system to provide suture holding capabilities. In particular, FIGS. 10 and 12 of Green, II illustrate locks 80 that are moveable within a channel 72 or 73. The locks 80 are not true cam cleats, as they are externally captured within a recess 74 or 75 and require an external bearing wall to effectuate a cam-like motion. During use, the channels 71 and 72 or 73 are necessary to facilitate a desired suture location. Unfortunately, the channels 71, 72, 73 to can overtly impede a surgeon's ability to readily visually confirm suture engagement and limit suture positioning in front of and behind the locks 80. Also, resilient foam pieces 85 must be adhered to the respective locks 80 as the locks 80 themselves are not capable of independently maintaining the pieces 85. As a result, the foam pieces 85 can easily separate from the corresponding lock 80, potentially leading to poor suture holding capabilities.
Many surgical procedures require selective holding of one or more sutures. While suture holding devices have long been available, certain drawbacks remain. Therefore, a need exists for a surgical suture holding device adapted to facilitate rapid assembly and disassembly of a suture thereto, along with providing the surgeon with the ability to visually confirm proper suture positioning relative to the holding device.